Taiwan’s National Health Insurance advances WHO goal

Taiwan’s National Health Insurance
advances WHO goal of universal coverage

Taiwan’s
National Health Insurance program is a global benchmark in
universal coverage and offers valuable lessons in delivering
high-quality, cost-effective medical care for all, according
to Minister of Health and Welfare Chen Shih-chung.

In an interview with Taiwan Today in the run-up to the
23rd anniversary of the NHI’s establishment March 1, Chen
said Taiwan’s wealth of experience can help the World
Health Organization realize its top priority as specified by
WHO Director-General Tedros Adhanom of achieving universal
health care around the world. Taiwan would welcome the
opportunity to share its expertise by participating in the
71st World Health Assembly, the decision-making body of the
WHO, May 21-26 in Geneva, he added.

“The NHI is
based on the principle of leaving no one behind. All
citizens and foreign residents are enrolled,” Chen said,
adding that Taiwan has consistently expanded coverage over
the years.

In 2013, all 60,000 prison inmates were
added to the program. A further measure broadening coverage
was implemented in December 2017 when babies born in Taiwan
to foreign residents—previously only eligible to join at
six months old—were included at birth. Chen said this
demonstrates Taiwan’s respect for health care as a
fundamental human right.

NHI users can access a wide
range of services spanning Western medicine, dental care and
traditional Chinese treatments at affordable prices. To
ensure fairness, premiums are set as a proportion of an
individual’s income.

This figure is currently 4.69
percent for employees, who pay 30 percent of this amount,
with their employers contributing 60 percent and the
government the remainder. In a survey conducted by the
Ministry of Health and Welfare last year, 85 percent of
respondents expressed satisfaction with the NHI.

“The NHI Administration under the MOHW is the single
payer for all medical services. This arrangement ensures
high levels of efficiency by significantly reducing
administrative spending,” Chen said.

In 2017,
these expenses accounted for 0.9 percent of total outlays.
According to the minister, this was the lowest in the
world.

In addition to controlling costs, the NHI has
led to continuous improvements in public health through the
regular introduction of cutting-edge medications and
treatments, Chen said. Recent initiatives include the
addition in January 2017 of newly developed antiviral
hepatitis C drugs for patients with advanced forms of the
disease, he added.

This move is expected to bolster
public well-being as the illness, a major cause of liver
cancer, is estimated to affect up to 600,000 people,
according to Taiwan nonprofit Liver Disease Prevention and
Treatment Research Foundation.

In 2017, the NHIA
allocated NT$2.4 billion (US$82 million) for the expensive,
highly effective oral hepatitis C medications, providing the
drugs to some 9,300 people. This year, a total of NT$4.25
billion has been earmarked with the goal of helping an
additional 17,000 patients.

“This is money well
spent. Dealing with the disease now will save a lot in the
long term by preventing more serious health conditions,”
Chen said.

Since the launch of the NHI, average life
expectancy in Taiwan has risen from 74.5 to 80.2 years. This
increase has drawn global recognition, with more than 50
foreign delegations visiting to learn about the program last
year alone, Chen said.

According to the minister, in
light of Taiwan’s rapidly aging population and the
pressure this will place on medical care spending, the
government is moving to ensure the long-term financial
viability of the system.

A major step in this regard
came in 2013 with the launch of the second-generation NHI.
Among other changes, the government boosted revenue by
levying a 2 percent charge—lowered to 1.91 percent in
2016—on supplementary income such as bonuses and stock
earnings. This measure expanded the program’s premium base
while making contributions more reflective of an
individual’s full income.

According to Chen,
another round of reforms will be launched in the next three
to four years with the aim of further boosting overall
efficiency and ensuring fairness in premium
contributions.

“While no national health insurance
program in the world is perfect, Taiwan’s model has been a
resounding success and can serve as a reference for other
nations,” he said. “Through technical meetings at the
WHA, Taiwan can learn from other countries and give back by
sharing its health care expertise.”

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